It’s been 40 years since Louise Brown, the first IVF baby, was born in the United Kingdom. At the time, it was both a miracle and controversial. Now in 2018, it has become a common medical procedure, not just in Britain and the US, but around the world. Now we have reached a new milestone.

2018 marks the birth of the 8 millionth IVF baby

So what is IVF all about?

IVF means in vitro fertilization. In vitro literally means in glass. The eggs and sperm are removed from the body, fertilized in a dish (it’s plastic, not glass though) and returned to the womb.

Why has IVF become so common?

Because it works. While IVF is not always successful, it is the only fertility treatment that has higher pregnancy rates than those of normal fertile couples. The technology has improved, and as the developing world has become more prosperous, these technologies have spread outside the US and Western Europe. IVF is now largely accessible to infertile couples worldwide.

Why do IVF instead of other medical procedures?

IVF is not necessarily the first treatment we try. Many patients will conceive with other lower tech ways such as intrauterine insemination or fertility pills and don’t need IVF. Some couples, such as those with damaged fallopian tubes or with very poor quality sperm, cannot conceive without IVF.

Lots of women seek out acupuncture to help them get pregnant, but does it really help?

Complementary and alternative medical treatments have become very popular for treating and preventing diseases, including the treatment of infertility. This may including vitamins and herbs and treatments such as acupuncture.

A number of researchers have found that acupuncture does improve fertility, at least in women who are undergoing IVF treatment, but some have not.

In order to figure out what it really going on, a group of doctors in Australia studies 824 women undergoing in vitro fertilization at their clinic. Half got real acupuncture (meaning the needles were placed in the right place according to acupuncture practice guidelines) and in the other half of patients, the needles were placed in locations that were not expected to have any effect. We call this last treatment "sham" acupuncture. They compared outcomes between the two groups.

They found out that women who had sham acupuncture were no more likely to get pregnant than those who had acupuncture done correctly. The pregnancy rates in these two groups were almost identical.

So what does this mean?

It is likely that acupuncture does not improve the chances for success with IVF, and if it does, the benefit is likely very small.

Were there any benefits to acupuncture in these women?

Yes. Women who received acupuncture were more relaxed and had a better sense of well being that those who had only sham acupuncture. This is not a small issue since IVF treatment is very stressful to the couples who are going through it.

Knowing this, should I still get acupuncture done?

Acupuncture is safe and comforting even if it may not be effective in IVF treatment. Other than the cost if it is not covered, there is really no risk to trying it.

What complications were actually less common in IVF pregnancies?

A group looking at IVF outcome data submitted through the Society for Assisted Reproductive Technology (SART) to the Centers for Disease Control (CDC) found that risk of perinatal mortality (the risk of stillbirth or newborn death) in very premature births was lower in women who conceived with IVF than those who did not. They found this to be true with both single births and multiple births (twins triplets, etc.) This informations was recently presented at the American College of Obstetricians and Gynecologists.

Does this mean getting pregnant with IVF is actually safer than getting pregnant on your own?

Probably not. Women who conceived with IVF were less likely to lose a premature baby than those who got pregnant on their own. We have no idea why this is the case. It could be due to more careful prenatal care with IVF pregnancies, or a higher socioeconomic level in couples doing IVF, rather that a results of what is actually going on with the pregnancy.

Why is this surprising?

There are many studies show a higher rate of complications in pregnancies that result from assisted reproduction such as IVF, and some others that show no effect. It was surprising to find out from such as large database, that at least one serious complication was less common.

Living in a high traffic area may hurt your chances for success with IVF

Research from Harvard presented at the annual meeting of the American Society for Reproductive Medicine suggests that women with a higher exposure to automotive traffic have lower IVF success rates than other women.

The researchers looked at 660 IVF cycles done over a 14 year period and compared their success rates to how far they lived from a class A roadway. A class A roadway means an interstate, state or US highway.

Women who lived more than a kilometer (0.6 miles) from a major roadway were 70% more likely to have a baby than those who lived within 200 meters (about 2 football fields) of a major roadway.

Interestingly, both groups of patients had similar pregnancy rates, but the those who live closed to the highway were more likely to miscarry.

Does this mean moving to a low traffic area will improve your chances of having a baby?

Not necessarily. It does show what we already know, that the environment we live in and the air we breathe plays a role in reproduction, as it does in other aspects of health.

Any couple who has gone through IVF knows what a rough and wild ride it can be, both physically and emotionally. For that reason, many couples give up on IVF early on, perhaps too early.

Why do women drop out of IVF treatment?

The reasons why women quite IVF are usually financial, when their insurance coverage or access to funds to pay for treatment run out, or emotional, when the thought of going through another cycle and the prospect of all the drugs, office visits and prospect of disappointment becomes overwhelming.

But, what happens to couples who persist and continue to go through IVF treatment cycles?

Fertility doctors in Bristol in the UK, sought to answer that question and what they found was encouraging. In their program, 1/3 of patients conceived on the first IVF cycle. In the next 3 cycles (1-4) the pregnancy rate was about 20% per cycle. While the rates were lower in cycles 5 and 6, they were not zero. Pregnancies continue to happen.

After 6 cycles of IVF, the cumulative pregnancy rate was 68%. In women between 40 and 42, there were successful pregnancies through the 9th cycle.

We've failed a few cycles of IVF. Should we give up?

Only you and your partner can answer that question. IVF tends to be more successful on the first round, but successful pregnancies do continue to happen with repeated attempts, sometimes even when it seems futile.

A gestational carrier with twins finds out one of the twins she was carrying was her own

Surrogate mom gives birth to twins boys, but one only was from her IVF cycle, the others was her own.

How is that possible?

When a couple uses a gestational carrier (what most people think of a surrogacy), embryos are produced from the eggs from the intended mother and sperm from the intended father. Sometimes the eggs or sperm are from a donor instead. Regardless, the embryos are placed in the womb of the gestational carrier, the woman who will carry the pregnancy and give birth for the intended parents. The carrier will take hormones to help prepare her uterus for pregnancy. This process has been done for years by fertility specialists, is highly successful and despite its complexity usually goes off without a hitch.

Not this time though...

A California woman agreed to be a gestational carrier for another couple. They did a form of IVF and the procedure seemingly went well. The carrier became pregnant and on ultrasound they saw twins. Since one embryo was transfered, the doctors naturally assumed the twins were identical. The pregnancy went well, the twins were delivered by cesarian section and went to live with the intended parents.

A month later, genetic testing revealed that the twins were not identical, and that the child's genetic parents were actually the gestational carrier and her husband.

How could this happen...

In a process called suprafecundation, a women who is already pregnant, or this case, in the process of becoming pregnant, can ovulate again.

When this happens, a woman who is pregnant would conceive a second pregnancy when she ovulates a month later. So, the second baby would be due a month later than the first. This type of event is exceedingly rare, but it looks like this is happened here, but on a shorter time frame.

Irish government proposes draconian new regulations of IVF treatments

Fertility treatments, particularly IVF have been subject to strict government regulations around the world, but has the Irish government's proposals gone too far this time?

Recently, the Irish government Department of Health has decided to develop a plan to provide IVF treatment for its citizens who suffer from infertility. While this is excellent news, they are also proposing some regulations, that are a bit over the top including...

One can understand their desire to refuse to cover treatments that would be less likely to result in a healthy live birth, but to threaten jail time for doctors and staff for performing IVF. That makes no sense. Hopefully, these absurd regulations are never enacted.

The first IVF baby Louise Brown was conceived near Cambridge, England over 3 decades ago...

Now it turns out that National Health Service in Cambridgeshire will no longer cover IVFtreatment in the place where it all began.

It is sad but true according the BBC...

The UK with its single payer government health system, like all other health systems, has limited funds and been forced to make a decision on where to cut. In Cambridgeshire, coverage for IVF was one of those cuts even though ivf treatment is recommended by the nhs' own guidelines.

In the United States, where we have a more fragmented system, some states such as New Jersey where we are located, mandate coverage. While the law remains intact and recently was amended to expand the definition of infertility, health care reform laws such as the Affordable Care Act (ACA, Obamacare) has actually reduced the number of women in our state who are covered for fertility treatment. When faced with multiple mandates, employers and insurers are forced to make decisions where to cut to control their premiums.

While there is plenty of talk these days about advocating a single payer government controlled system, it is not clear that such a change will benefit couples with infertility. While some countries with national health care systems do cover IVF and other treatments, it is often the first item on the chopping block when costs are getting out of control. It is certainly the case in Britain.

For those who advocate for the availability of treatment of infertile couples, be careful what you wish for. Increased access to medical care does not necessarily mean increaseD access to fertility care.

Recent studies suggests that sugary drinks, even those with artificial sweeteners may harm the chances for pregnancy.

Although it is far from conclusive, several recent studies suggest that sweet drinks may have an adverse effect of a woman's chance for pregnancy, including...

Harvard doctors found that drinking one sugary drink a day can lower the success rate of IVF by 12% and more than one sweet drink a day by 16%

Brazilian researchers found that consuming sugary or artificially sweetened drinks reduced embryo quality and the chances for an embryo to implant. interestingly

Interestingly this effect did not occur with unsweetened coffee.

The reason for this is not totally clear, though we know both obesity and polycystic ovarian syndrome (PCOS), which are both associated with infertility and miscarriage, and associated with changes in how the body handles sugar, can lower the chances for pregnancy.

So, what should I do?

It is a good idea to keep sugary products to a minimum when you are trying to get pregnant, and to minimize artificial sweeteners such as Splenda, Equal or Sweet-and-Low. These sugar substitutes may be just as harmful as sugar itself.

Don't panic. Women who use artificial sweeteners and drink sweet drinks still get pregnant all the time, even if the chances are a little lower. There are many factors that go into your fertility, so it is far from clear that consuming these drinks is actually harms your chances for pregnancy.

IVFtreatment can be incredibly stressful, even when it is successful. Imagine how difficult IVF can be when it is not? That is likely why so many couples give up after an unsuccessful IVF cycle.

According to reasearchers in the UK, almost a third of couples who are not successful at IVF and stop treatment will conceive on their own, although that might take up to 2 years.

Surprisingly, many of the couples who did conceive this way were not as thrilled as one might expect. Some couples have moved on in their life situations, and others were felt that maybe they never needed IVF in the first place.

An unsuccessful IVF cycle can be downright devastating to couples going through fertility treatments, particularly when the cycle results in a miscarriage. Between the guilt, the disappointment and the "if I only had's," many couples leave the experience totally devastated. But are those concerns really warranted?

Probably not.

Fertility specialists have known for years that women who miscarry, are actually more likely to have a baby, even though most patients are a understandably somewhat skeptical about this.

To look further into this fertility specialists at the University of Aberdeen in Scotland looked at well over 100,000 IVF treatment cycles performed between 1999 and 2008. They were particularly interested in women who had a first cycle at that was unsuccessful, whether that was there was a miscarriage or no pregnancy at all. What they found was not surprising considering what we already know.

Women who had miscarried had a higher 49% chance of livebirth in the subsequent IVF cycle as compared to only a 30.1% chance had the first cycle not resulted in a pregnancy.

So, what does this all mean?

Don't be in a rush to give up. Lots of women conceive on subsequent cycles.

Having a miscarriage from IVF, and likely from other treatments, means you are more likely to have a baby, not less likely.

No surprises here. We have been advising our patients to consider intrauterine insemination (IUI) as an alternative to IVF for years.

A recent study again confirms the that IUI is a reasonable approach to treating infertility. Researchers in New Zealand found that women who did IUI along with oral medications (clomiphene was used in this study) for 3 months has similar pregnancy rates to those who went straight to IVF on their first treatment cycle.

So, why would one to go straight to IVF? IVF offers several advantages over inseminations:

IUI also has some significant advantages:

lower multiple birth rates when oral fertility drugs are used and multiple embryos are transferred with IVF

All couples have a different comfort level when it comes to fertility treatment. Like most medical treatments, fertility treatments involve balancing the effectiveness and risks of the various options. This is an important discussion to have with your doctor.

Unfortunately, changes in the health care system, such the Affordable Care Act (Obamacare) have affected coverage. Fortunately, New Jersey state employees and most NJ teachers continue to be covered under the mandate. There are some gaps in this coverage, particularly for single women and those in single sex/lesbian relationships.

With an act of the NJ state legislature and the signature of Governor Christie, that has changed. The infertility mandate has been updated to reflect the new ASRM definition of infertility and includes the following:

A male is unable to impregnate a female;

A female with a male partner and under 35 years of age is unable to conceive after 12 months of unprotected sexual intercourse;

A female with a male partner and 35 years of age and over is unable to conceive after 6 months of unprotected sexual intercourse;

A female without a male partner and under 35 years of age who is unable to conceive after 12 failed attempts of IUI (intrauterine insemination) under medical supervision;

A female without a male partner and over 35 years of age who is unable to conceive after 6 failed attempts of IUI under medical supervision;

Partners are unable to conceive as a result of involuntary medical sterility;

A person is unable to carry a pregnancy to live birth; or

A previous determination of infertility pursuant to the law.

This update in coverage becomes effective in August 2017 and only applies to New Jersey state employee and teacher plans.

At Princeton IVF, we participate in the affected New Jersey State Health Benefits Program and School Employees Health Benefits Plan that are affected by these new rules, including NJ Direct from Horizon Blue Cross Blue Shield and Aetna for NJ state employees.

In Vitro Fertilization US reaches a new record.

The one millionth IVF baby was born in the United States in 2016

This year, the Society for Assisted Reproductive Technology announced that the 1 million IVF baby was born in the United States. IVF has been around for over 30 years, and performed successfully at multiple clinics in the United States and worldwide since then. Worldwide, there have been millions of babies born from IVF, but limited coverage in the United States has delayed reaching this milestone.

When is it time to give up on IVF?

Most couples give up on In Vitro Fertilization if it fails after a few attempts, but not this Israeli couple.

While research does show that most couples who do not give up will eventually be successful with IVF, many give up due to some combinations of physical, mental or financial exhaustion. In a testament to determination, an Israeli couple tried a total of 18 IVF cycles. On that final cycle, the Hanans became pregnant delivered triplets at 32 weeks of pregnancy at a hospital near Tel Aviv, Israel.

Dr. Seth Derman was invited to address a group of students at Princeton University's Center for Jewish Life as part of the their Fellowship in Jewish Medical Bioethics. He discussed with a group of engaged, intelligent young women and men about what Reproductive Medicine specialists do to help their patients have a child, and the exciting technology and fundamental ethical issues that go along with the territory. The students came away a better understand of the ethical and emotional issues that face couples undergoing fertility treatment.

HEALTH MATTERS: Assisted reproductive technologies available

By Seth G. Derman

This article previously appeared in the Princeton Packet

Infertility  the inability to get pregnant or stay pregnant  is a common problem in the United States, affecting about 10 percent of women of childbearing age, according to the Centers for Disease Control and Prevention.

How does IVF work?

When most people talk about ART, they are referring to in vitro fertilization or IVF. IVF has been used for decades to help women get pregnant. In fact, the first IVF baby is now over 30 years old and has a child of her own.

With IVF, eggs are surgically removed from the body, fertilized with sperm and allowed to grow in the laboratory. In vitro literally means “in glass,” as the fertilization and early development happens in a laboratory dish.

Fertilization can occur naturally with the sperm selecting the egg or in cases where there are problems with the sperm, can be assisted with doctors inserting the sperm directly into the egg. After 3-6 days the embryos are inserted directly into the uterus.

While IVF was first developed to help women with missing or damaged fallopian tubes, it is now routinely used to treat infertility caused by many different problems such as sperm problems, endometriosis, unexplained infertility and any other type of infertility that does not respond to more conventional treatments.

Other methods of ART include gamete intra-fallopian tube transfer (GIFT), zygote intra-fallopian tube transfer (ZIFT) and tubal embryo transfer (TET). With these, the embryo is transferred to the fallopian tube through laparoscopic surgery instead of into the uterus, except with GIFT in which the eggs and sperm are inserted into the tube and fertilization occurs inside the body. With ZIFT and TET, fertilization occurs outside the body. These procedures are rarely performed today as their advantages in terms of pregnancy rates have been overcome by modern laboratory technology and improved methods of embryo transfer.

Who is a candidate for IVF?

The majority of patients who are candidates for ART suffer from tubal problems, sperm problems, unexplained infertility or certain inherited genetic diseases, according to the Society for Assisted Reproductive Technology (SART). Candidates for ART generally have:

No evidence of premature menopause

At least one accessible ovary, and

A normal uterus

Menopause and ovarian function are irrelevant for candidates using donor eggs. SART recommends that all ART candidates should be in good health and have no medical conditions that would pose a serious health risk to themselves or the children they would carry.

How successful is IVF?

Success rates vary and depend on many factors. Some factors that can affect the success rate of ART include the following:

Age of the partners

Reason for infertility

Type of ART

If the egg is fresh or frozen

If the embryo is fresh or frozen

In addition, the clinic itself can have an impact on success rates, according to the CDC. Princeton IVF's affiliated Laboratory takes advantage of the latest in “clean room technology,” to help improve pregnancy rates.

A specialized ventilation and HVAC system allows for improved air quality, flow and temperature control. Air quality is further enhanced by the use of eco-friendly, low VOC (volatile organic compounds) paints and building materials. This type of technology can have an enormous impact on embryo quality, survival and clinical outcomes of IVF treatment, research has shown.

What are risks of IVF?

The biggest risk factor associated with ART is multiple fetuses, but that can typically be prevented or minimized in many different ways. Other risk factors include surgical risks from the egg retrieval, side effects of the fertility drugs for mom and risks associated with pregnancy.

And while ART can be expensive and time-consuming, it has enabled many couples to have children that would have otherwise not been conceived.

What is pre-implantation genetic testing?

Pre-implantation genetic testing (PGD) and pre-implantation genetic screening (PGS) can be used following IVF to diagnose genetic diseases prior to implanting the embryo in the uterus. Doctors can test a single cell from the embryo to determine chromosomal abnormalities that, among other things, can lead to miscarriage and birth defects.

Talk with your doctor

If you are one of the millions of couples struggling with infertility, talk with your doctor about ART. For many, it is a promising option that can help couples realize the joy of parenthood.

Seth G. Derman, MD, FACOG, is board certified in gynecology and reproductive endocrinology. He is a fellow of the American College of Obstetricians and Gynecologists and a member of the medical staff at University Medical Center of Princeton at Plainsboro.

Researchers in Greece report being able to generate eggs from women who have already gone through menopause.

Doctors in Greece may have found a way to make postmenopausal women grow eggs.

As reported in the New Scientist, fertility researchers have been looking into a new way of potential of helping women in menopause continue to produce eggs. As a women ages, the number and quality of her eggs inevitably declines. By the average age of menopause at age 51-52, there are relatively few eggs left in the ovary, and those that do remain, generally are of such poor quality that ovulation just simply ceases. When this happens, fertility disappears, menstrual periods stop and the symptoms of the lack of estrogen such as hot flashes and vaginal dryness get worse. These symptoms of menopause actually start years before the periods stop but the potential for pregnancy, even if it small, remains.

What if there was a way to reverse this? With this in mind, a team in Greece tried using something called platelet-rich plasma to see if it was possible to regenerate eggs. Platelet rich plasma (PRP) has been used with some success to try and regenerate injured bone and muscle. Among other things, it contains a mixture of growth factors, chemicals found throughout the body that are involved in the natural processes of inflammation and tissue repair. The idea was to try to use the PRP to regenerate ovarian tissue and somehow activate the dormant eggs to grow.

Regenerative medicine for reproductive medicine

The researchers did find some success, and a number of these women did begin to ovulate again. In one patient, they were even able to harvest and fertilize some of these eggs through IVF. The embryos were frozen for later use, so it is unknown whether this procedure can actually result in a pregnancy.

There are still lots of unanswered questions before we can consider this an option for infertile couples in menopause, early or otherwise. We know that the eggs are generally of poor quality in women in their late 40's and when there is fertilization that embryos are generally unhealthy. These embryos rarely implant, and when they do the risk of miscarriage and genetic disorders such as Down Syndrome is quite high. It is not uncommon for women in above 45 to produce enough eggs to do IVF, but it is uncommon that any are good enough to result in a healthy pregnancy. Would the eggs from PRP be any different?

While it is possible that the PRP may improve the quality of these eggs to the point where they can result in a healthy baby, it is just as likely (if not more so) that they they will not. We don't know if the center that reported this data will be able continue to get patients to respond as time goes on or if other fertility clinics will be able to replicate these results. We also do not know if the benefits are short acting or long term, and if they are long acting what the implications are for these patients. Does it mean that a 60 year old can now conceive on her own or how will the continuation of menstrual cycles beyond the natural time affect a woman's risk of diseases such cancer or heart issues? The implications, both medical and ethical, could be enormous.

At this point, it is still just an interesting idea. Still, the prospect of being able to restart a menopausal ovary is intriguing to fertility specialists and their patients.